TagCipriani

It’s an annual Reading of the Week tradition. At the end of each year, we pause, take stock, and consider the best selections of the past 12 months.

2018 was an eventful year.

Start here: the federal government legalized the recreational use of cannabis.

We have heard so much about legalization over these past few years, that the event itself seemed almost anti-climactic. But remember: Canada is only the second country in the world to do this.

And 2018 has seen further evidence that stigma continues to fade: governments across the country have committed themselves to increased funding for mental health; more people spoke of their experiences with mental illness; more people talked about previously taboo topics, such as suicide.

And so with an eye on the future, let’s look back at the last year. In this final Reading of 2018, we look at a few memorable selections. Enjoy.

September 27, 2018 / David Gratzer / Comments Off on Reading of the Week: Do Antidepressants Beat Placebo? Does Measurement-based Care Work? Four Papers and Some Thoughts on a Fourth Anniversary

From the Editor

This month, the Reading of the Week – in its present form – turns four.

Today, the Readings are emailed out from sea to sea to sea. It’s a big evolution from the first Readings, started more than six and a half years ago, with me handing out photocopies of papers on the inpatient ward where I worked.

To celebrate our silk anniversary, I’ve picked four major selections from the past four years. I’ve also included some papers that haven’t been discussed – but should have been.

Silk: good for a fourth wedding anniversary, but a fourth Reading anniversary?

May 10, 2018 / David Gratzer / Comments Off on Reading of the Week: MDMA for PTSD – the New Lancet Psychiatry Paper; Is the Club Drug Really a Breakthrough Drug?

From the Editor

“When it kicked in, it was like an epiphany. I could see all these things from combat I was afraid to look at before, and I had a totally new perspective. I relived the parts of me I had lost. I realized I had viewed myself as a monster, and I was able to start to have some compassion for myself. It was a turning point, and for the next year I continued to get better.”

In a recent article on MDMA (often called Molly or Ecstasy), The New York Times quotes U.S. Marine Nigel McCourry, who has PTSD, talking about his experience taking the drug. So – is there a role for MDMA in the treatment of PTSD? In a new paper published in The Lancet Psychiatry, researchers seem to find there is. In the study, therapy sessions were enhanced with MDMA; after the sessions, 68% of the patients no longer met the clinical criteria for PTSD.

The paper has gained international attention. The New York Times covered it (and quoted McCourry). So did Global News with an online article headlined: “‘Party drug’ MDMA touted as breakthrough therapy for PTSD patients.” The Independent’s story begins: “MDMA ‘cures’ sufferers’ post-traumatic stress disorder in a few weeks during study.”

MDMA: Colourful pills – helpful pills?

In this Reading, we consider the paper behind the headlines, and the Comment piece that accompanies it. We also consider what to tell patients if they ask about MDMA for PTSD.

Last week, I spoke to a patient about antidepressants. “But do they really work?” she asked. While antidepressants are commonly prescribed, many patients wonder about them. That’s not surprising: in popular culture, these medications are often portrayed as risky and unhelpful. Just a few weeks ago, the most popular women’s fitness magazine in the world described fawningly how a woman quit her medications and felt better (“I felt more alive and in control of my emotions with each passing day”). A few years ago, a major study suggested that antidepressants basically match placebo in efficacy; 60 Minutes covered it.

And now there is the new Cipriani et al. paper. “We found that all antidepressants included in the meta-analysis were more efficacious than placebo in adults with major depressive disorder…”

Is this the biggest psychiatry paper of the year? Certainly, it may be one of the most impressive. It took six years of effort. Oxford University’s Andrea Cipriani and his co-authors drew from all available data – published and unpublished, and covering more than 500 trials.

The media coverage has been incredible. The Guardian summarized the paper with the first two words of its article: “Antidepressants work.”

In this Reading, we look at the big study and mull the big implications.